5.  The applicant was born in 1941 and lived in the village of Rassylnaya, Kursk Region. He was serving a sentence in a correctional colony in the Kursk Region until his release in April 2012.
6.  On 29 September 2006 the Kursk Leninskiy District Court found the applicant guilty of having beaten his female partner to death in a drunken rage. The applicant was sentenced to eight years’ imprisonment. The judgment became final on 14 December 2006 when the Kursk Regional Court upheld it on appeal.
7.  According to the applicant, following his arrest in January 2006 he was detained in inhuman conditions in facility no. IZ-46/1 in Kursk. On 26 December 2006 he was transferred to a correctional colony to serve his sentence.
8.  As is stated in the applicant’s medical records, on 28 November 2001 he suffered a large transmural myocardial infarction and underwent lengthy treatment in a cardiology clinic. Having been examined in October 2002 by a cardiologist, the applicant was diagnosed with coronary artery disease, postinfarction cardiosclerosis and cardiac aneurysm, a severe form of chronic arterial hypertension and a latent form of urolithiasis. He was classed as permanently (category 2) disabled as a result of his illness.
9.  In March 2005 the applicant had another myocardial infarction.
10.  On 2 January 2006, the day following his arrest, an ambulance was called for the applicant, who had complained of a severe heartache. Having learned that the applicant suffered from stage 3 arterial hypertension and coronary artery disease, the emergency doctors provided him with urgent assistance and authorised his further detention in facility no. IZ-46/1.
11.  Having been admitted to the detention facility, the applicant did not cease to complain about his state of health. He claimed to be experiencing a severe pressing chest pain and shortness of breath. Following an examination by the head of the medical unit of the detention facility ten days after the applicant’s admission, his diagnosis of severe essential hypertension (stage 2-3) with a very high risk of development of further cardiovascular complications was confirmed. The applicant was prescribed treatment with four medicines (nitroglycerine, to be taken in case of a sharp chest pain, aspirin, Nitrosorbide (isosorbide dinitrate) and Diroton (lisinopril/hydrochlorothiazide)).
12.  On 19 January 2006 the applicant complained to a prison physician on duty that he was experiencing a sharp pain in the left side of his chest reverberating into the left arm and shoulder blade. Having copied the diagnosis and the treatment to be followed from the medical certificate issued by the head of the medical unit on the previous occasion, the physician sent the applicant back to the cell. Subsequent medical examinations by prison physicians ended with a similar result. The applicant was told to continue with the treatment prescribed by the head of the medical unit.
13.  In March 2006 the applicant complained to warders of angina which he could only relieve with nitroglycerine, occasional loss of consciousness, acute elevation of the pulse, reflex pain in the left arm, pain in the eyes, and extremely high blood pressure. On 28 March 2006 he was transferred to the therapy ward of the Kursk Regional prison hospital, where he remained for two months with his state being considered moderately severe. The prison doctors’ diagnosis was: “coronary artery disease, recurrent myocardial infarction, extensive transmural scarring of the anterior, lateral and frontal walls of the left ventricle of the heart, postinfarction cardiosclerosis (myocardial infarctions in 2001 and 2005), stable exertional angina, chronic aneurysm of the left ventricle of the heart, stage 3 arterial hypertension, [and] singular premature ventricular complex”. During the entire period of his admission to the hospital the applicant had eleven electrocardiogram examinations (hereinafter – “ECG tests”). His blood and urine were also clinically tested on several occasions. However, he was never examined by a cardiologist. The medical team attending on him included general physicians, the head of the therapy ward, a dermatologist, an ophthalmologist and a dentist, depending on which medical specialist was on duty on the day of the applicant’s examination. During each examination the applicant continued complaining of angina, fatigue, shortness of breath and that his “heart had stopped working [properly]”.
14.  On release from the prison hospital on 26 May 2006, the applicant’s condition was considered satisfactory with the state of his health having improved during treatment in the hospital, despite his having continued to suffer from fatigue and an aching pain in the chest during physical exercise. The release certificate also indicated that, in addition to the two myocardial infarctions in 2001 and 2005, the applicant had suffered a third one in 2006. He was prescribed symptomatic treatment with a long list of medicines.
15.  Following his release from the hospital the applicant continued complaining of angina. He was recommended close supervision by prison medical personnel and was prescribed treatment with four heart medicines. On 3 July 2006 the applicant complained to the attending prison doctor of a severe headache and pain in the chest. He was given a shot of magnesium solution.
16.  On 20 July 2006 the applicant suffered a heart attack during a trial hearing. Having heard the applicant’s complaints of severe chest pain for the last three days, shortness of breath, sweating, dizziness and elevated heart rate, emergency doctors called to the courthouse suspected that he could have suffered another myocardial infarction. Having provided the applicant with urgent medical assistance they took him to the medical unit of detention facility no. IZ-46/1. He was to remain under close supervision by the prison medical personnel and urgent admission to a hospital was recommended, should his condition deteriorate.
17.  According to the applicant’s medical records, the following medical examination took place on 3 August 2006, when a physician from the Kursk Regional prison hospital came to the detention facility to check on the applicant. Having noted that the applicant had already survived three myocardial infarctions, the physician recommended his admission to the hospital when the convoy service could organise his transfer. Four days later the applicant was sent to the Kursk Regional prison hospital, where he remained until 25 August 2006.
18.  As is clear from medical record no. 767 drawn up in the hospital and from the Government’s submissions, while he underwent a number of clinical blood and urine tests, as well as a chest X-ray exam, the applicant was not subjected to ECG testing in the hospital. Similarly, having been examined by a number of medical specialists, including an ophthalmologist, a neurologist and a dentist, the applicant was not seen by a cardiologist during that stay in the hospital.
19.  The Government’s submissions do not contain any further records of the applicant’s medical examinations or treatment until his transfer to correctional colony no. 2 in the Kursk Region on 26 December 2006. On admission to the colony the applicant was placed on a list of inmates requiring close medical supervision, given the seriousness of his condition. Following a complaint of dizziness and discomfort in the chest, the applicant was taken to the medical unit in the colony and was advised to continue with the treatment with four heart medicines. An examination by a prison physician five days later resulted in an amendment of the treatment with the introduction of an increased dose of medication. During a subsequent examination a week later new drugs were introduced to the applicant’s regimen. He was released from the medical unit on 19 January 2007.
20.  On 26 February 2007 the applicant was examined by a medical panel comprising a number of specialists, including a physician, a surgeon, an ophthalmologist, an otolaryngologist, a tuberculosis specialist, a physiatrist, a dentist and a drug addiction specialist. The panel confirmed the diagnosis of a severe case of arterial hypertension, a coronary disease and postinfarction cardiosclerosis and declared the applicant permanently disabled. Another examination by a physician took place on 20 March 2007 with the diagnosis and recommendations for treatment remaining without any amendments. A handwritten note enclosed by the Government with their submissions showed that a large number of medicines required for the applicant’s treatment had been provided to the detention facility by the applicant’s son.
21.  In April 2007, following an acute deterioration of his condition, the applicant was again admitted to the colony medical unit for treatment. As is evident from extract no. 315 of his medical records, during a one-month stay in the unit the applicant was not examined by a cardiologist. A record of the applicant’s ECG testing could not be interpreted, as the unit did not have the necessary specialist. Ultrasound scanning was also impossible, as the unit did not employ the required specialist either.
22.  After his release from the medical unit, the applicant was examined once a month by a colony physician or a drug addition specialist who was acting as an on-duty doctor on the relevant days.
23.  On 30 August 2007 the applicant arrived at the colony medical unit complaining of a sharp pain in the heart area which he could not relieve with any heart medicine. He was immediately accepted by the unit for inpatient treatment. Having been examined by a prison physician on the following day, the applicant was released on the basis that the examination had not revealed any negative changes in his condition.
24.  In October 2007 the applicant sought assistance from the medical unit once every few days, complaining of high blood pressure, angina and heavy breathing. A prison physician, a medical assistant or a drug addiction specialist measured his blood pressure and slightly amended his drug or food regimens.
25.  Following a number of repeated, similar complaints being made by the applicant between January and April 2008 and his subsequent examinations by prison physicians, a medical assistant or tuberculosis specialist, he was sent to the Kursk Regional prison hospital for treatment on 15 April 2008. On admission to the hospital, the examining physician noted that the applicant’s hypertension had progressed to stage 3. The applicant was visited by a hospital physician nearly every day and underwent clinical urine and blood testing. He was not seen by a cardiologist but received ECG testing once, on the day following his admission to the hospital. On 13 May 2008 the attending physician performed a visual examination of the applicant and measured his pulse and blood pressure. Having been prescribed treatment with long-term nitrates and admission to the colony medical unit for inpatient treatment, the applicant was released from the hospital on 15 May 2008, despite his complaints of stabbing pain in the heart area, dizziness and blackouts.
26.  The applicant’s medical records do not show that the recommendation that he be admitted to the medical unit was followed. They list six consultations with a prison physician between the end of May 2008 and March 2009. The entries in the records indicate that the consultations comprised a discussion about the state of the applicant’s health and the progress of his condition, and obtaining an authorisation to administer an injection of a painkiller in the event that the applicant experienced particularly strong pain.
27.  It appears that the applicant suffered another episode of illness towards the end of March 2009, having complained to the colony staff of severe angina. For three days he was given injections of a painkiller and provided with Diroton to stop the attack. The prison physician relieved the applicant from having to take part in any type of activities related to inmates’ everyday life, only authorising him to attend the morning roll call. On 7 April 2009 the applicant was admitted to the Kursk Regional prison hospital where he remained until 21 April 2009, having undergone ECG testing and having received treatment with nitrates.
28.  On 14 September 2009 the applicant was admitted to the colony medical unit for inpatient treatment. The medical personnel recorded that his blood pressure was very high and prescribed treatment with nitrates and antihypertensive medicines. Physicians and medical assistants continued recording episodes of hypertension and heart attacks between October 2009 and February 2010, having provided symptomatic treatment. The applicant remained in the unit until 27 January 2010.
29.  In April 2010 the applicant was transferred to correctional colony no. 9 in the Kursk Region. A colony tuberculosis specialist who had examined the applicant on his admission confirmed the previous diagnosis, having noted the negative progress of his arterial hypertension and chronic heart disease. In April 2010 the applicant suffered two episodes of hypertensive emergency, having also complained of periodic angina. Towards the end of May 2010 he had another episode of hypertensive emergency and heart attack, having for several consecutive days experienced pain in the chest, headache, dizziness, nausea and angina which could only be relieved with an injection of papaverine. Colony physicians also provided the applicant with aspirin and nitrates and planned to have him transferred to a prison hospital for in-depth examinations and treatment.
30.  Between 1 and 25 June 2010 the applicant was admitted to the therapy ward of the Kursk Regional prison hospital, where he received treatment by the hospital’s physicians. On admission to the hospital the attending physician noted the critical development of the applicant’s arterial hypertension, with a blood pressure reading of 220 over 120, and recommended daily monitoring of the applicant’s condition by way of ECG tests and measuring of his blood pressure, an ultrasound scan of his heart accompanied by a Doppler examination, a scan of the major blood vessels of the heart, and examinations by a cardiologist, a neurologist and a cardiac surgeon. There is no indication in the applicant’s medical records that the recommendations, save for the performance of two ECG tests, were complied with. On the basis of the two ECG tests performed on 3 and 11 June 2010, an ultrasound examination of the abdominal cavity, and clinical blood and urine exams and visual examinations, the attending physician authorised the applicant’s release from the hospital on 24 June 2010. During the last consultation with the physician, the applicant continued complaining of pressing chest pain, heart pain and a burning sensation behind the ribs which even arose during simple physical exercise, such as a slow walk for ten minutes or using stairs. He also stressed that he was constantly experiencing feelings of fear and panic attacks at night, when he was covered in a cold sweat and shivering.
31.  Following his release from the hospital and until February 2011 the applicant sought urgent medical assistance at least once a month, having persistently complained of chest pain, headache, shortness of breath, dizziness and fatigue. Emergency care, including injections with muscular relaxants to arrest acute arterial spasm and provision of nitrates and medicines to lower his blood pressure, was provided each time by a colony tuberculosis specialist or by a psychiatrist. Having received emergency treatment, the applicant was sent back to the colony unit with the recommendation to continue taking his medicines until the next episode of illness requiring the urgent attention of the medical staff. The hypertensive emergencies recurred in May and July 2011, with similar emergency actions being taken by a colony psychiatrist or the head of the medical unit to stop the attacks.
32.  The hypertensive emergency in July 2011 was the most recent attack of the illness described by the Government in their submissions to the Court. According to them, the applicant had remained under the supervision of a colony physician, with his condition being considered satisfactory. He had received “necessary” inpatient medical treatment.
33.  According to the applicant, his condition had continued deteriorating in view of the fact that the colony and the prison hospital had not been equipped to address his needs, as they had been lacking necessary equipment, specialists, including a cardiologist, and had been unable to provide emergency resuscitation assistance if need be. His complaints to various State authorities, including the Russian Ministry of Health and Social Development, the deputy head of the Kursk Regional Service for the Execution of Sentences, prosecution authorities and the administration of the detention facilities, had either not brought about any response or had been addressed in a very superficial manner. For instance, in January 2009 the applicant had lodged an action with the Kursk Leninskiy District Court, complaining of inadequate medical care in detention and seeking compensation for damage. His complaint had been returned with a letter on 4 February 2009. While the letter of 4 February 2009 was submitted to the Court, a copy of the decision disallowing the complaint was not provided by either party.
34.  In response to another complaint by the applicant, on 1 July 2009 the deputy head of the Kursk Regional Service for the Execution of Sentences sent a letter, which read as follows:
“Your complaint, sent to the head of the medical department of the Kursk Regional Service for the Execution of Sentences, has been examined by staff members of [that] department.
An attending doctor, and not a patient, is competent to prescribe diagnostic examinations. By virtue of paragraph 125 of the Rules of Internal Order in Correctional Facilities ... you may receive additional prophylactic medical treatment (including a consultation with an independent medical specialist – a cardiologist), having paid for it yourself.”
35.  In his most recent letter to the Court in May 2012, the applicant informed it that upon a request from the administration of the prison hospital he had been released from detention in view of the seriousness of his condition. He attached a copy of a decision issued on 29 March 2012 by the Kursk Leninskiy District Court authorising his release. As is stated in that decision, having heard the representatives of the prison hospital, who had argued that the applicant was suffering from a very serious heart condition which, under domestic laws and regulations, precluded his serving the sentence, the fact that he could not receive the necessary medical assistance in detention and that the prognosis for his condition was unfavourable, the District Court accepted the request for release.
36.  Having been released from detention, the applicant was immediately admitted to the cardiology department of a hospital close to his place of residence. It also appears from the medical documents submitted that upon his release prison doctors advised him to consult an oncologist. The applicant stated that he had followed that advice and had been diagnosed with cancer.